The ultimate guide to private healthcare, revealed by top doctors: The TEN things you must know, how to get treated fast - plus we've crunched the numbers to save you hundreds
The NHS faces a near-record workload, with more than seven million people in England alone awaiting hospital treatment. Three million of those have been in the queue for more than 18 weeks.
This, experts say, is the main reason why more and more patients in the UK are turning to the private sector to speed up the process – even if it means forking out more hard-earned cash.
One in eight Britons is now thought to have private medical insurance – policies they either pay for, or which come as part of a salary package – to cover themselves and, in many cases, their families, for diagnosis and treatment in the event of serious illness.
Demand has been so strong in recent years that private medical insurance policies are now as popular as they were back in 2008 – before the financial crash forced many firms and individuals to tighten their belts.
Meanwhile, there has also been a 30 per cent surge since the Covid pandemic in the number of people opting for self-pay healthcare – funding private tests and treatments as and when they are needed from their own pockets, rather than paying out hundreds or even thousands of pounds each year for insurance premiums for policies they may never use.
The most common procedures which people pay for privately are cataract surgery or hip and knee replacements.
It’s a sign of the growing normalisation of people privately funding urgent healthcare, while continuing to rely on the NHS for routine checks and treatments – such as cancer screening, prescriptions and vaccines.
But it’s no easy task to navigate the minefield of private medicine in order to secure the policy that best suits you.
It’s no easy task to navigate the minefield of private medicine in order to secure the policy that best suits you
Should you cough up monthly premiums for the peace of mind offered by a medical insurance scheme, or instead dip into your savings for self-pay solutions when prompt treatment is needed and NHS delays are simply too much to bear?
For the latest in our series of must-read guides, we explore the benefits and pitfalls of funding your own healthcare…
How to ensure good value for money
1. Take out a policy before you hit 50
As we get older, the chance of developing chronic illnesses increases. That’s why it’s best to take out insurance early on, says Chris Smith-Brown, clinical advisor to the Private Healthcare Information Network (an independent body set up by the Government to provide impartial advice to patients). This is because fewer things will be excluded and premiums are usually lower.
Once you get past 50, you may face challenges in securing private medical insurance, as the risk of developing long-term health conditions increases – although there are special insurance packages you can get for those over 55.
Chris Smith-Brown says: ‘Rates tend to be lower when you are younger and, though they can go up as you age, some can stay the same – it depends on the policy and the rate of inflation.’
2. Check the details of cancer care
Fear of delayed NHS cancer diagnosis and treatment is one of the main reasons people go private. But there are pitfalls to be aware of with a private medical insurance policy, warns Chris Smith-Brown.
‘Most policies will cover standard cancer treatments such as surgery, radiotherapy and chemotherapy,’ he says.
‘But double-check how long they pay out for, as some insurers only cover the first 12 months of chemotherapy.’ At this point you would have to self-fund treatment or go to the NHS.
You can choose to save money by excluding cancer care from your policy altogether, which can significantly reduce the cost (by up to £300 or £400 a year).
Always check the small print – some policies will not pay out for cancers that develop within the first six months or so after the insurance is taken out, on the basis that the patient – although they did not have a diagnosis at the time – may have been aware that they might have a serious problem (and took insurance out to cover it just in case).
If you have had cancer in the past, some insurers might exclude paying for treatment if you develop that cancer again. Others might decide based on how long ago it was.
3. Declare all pre-existing conditions
Insurers don’t usually cover pre-existing illnesses. But they will sometimes include them if the patient’s medical history demonstrates that, for example, their high blood pressure or diabetes has been well-controlled for two years or more.
But Chris Smith-Brown adds that it’s essential anyone buying health insurance declares every illness they have ever had, or it could invalidate the policy.
Sometimes insurers rule out covering a pre-existing chronic condition (say, diabetes) for the first two years, but agree to cover it if it worsens after that point.
The idea is that if the condition appears well managed for the first two years, any worsening is classed as a ‘new’ development and therefore qualifies for cover.
4. Check what the policy doesn't cover
It’s just as important to find out exactly what your private medical insurance policy does not include as what it does, says Chris Smith-Brown.
‘Find out if it covers things like imaging (such as X-rays or CT and MRI scans) and diagnostic checks. Some policies might limit the number of scans or blood tests that are covered in the space of a year.’ This matters if you need repeat investigations.
‘Similarly, there might be restrictions on how many hospital admissions are covered. This might be in the form of an amount of money allocated to it, or a cap on the number of admissions.’
5. Over 70? Consider self-pay
Once you hit 70, getting a new health policy can be difficult or very expensive, as insurers are much less inclined to take a risk on someone who’s more likely – due to their age – to become ill.
There are policies aimed at older buyers, but in the over-70s it usually excludes any ailment that’s developed within the past five years.
‘We tend to see more use of self-pay private healthcare among people in their 70s onwards,’ says Chris Smith-Brown.
6. Cut your premiums with a larger excess
Just as with car or home insurance, monthly private medical insurance bills can be reduced if you agree to pay a larger excess – the amount of the claim which is paid for out of your own pocket.
Standard excess is usually between £250 and £500.
The downside is you might end up spending £400 here and there for scans or tests without benefiting from your cover.
You can choose a policy with no excess (in which case your premiums are likely to be higher), or you can opt for a higher amount, bringing down the monthly rate.
For example, if you agree to an excess of £100 and have a consultation that costs £200, you will pay £100 and the insurer the rest.
Some policies ask you to pay the excess each time you claim, others that you pay it once a year even if you make multiple claims.
7. Funding a struggle? Try a self-pay loan
Financing an operation or treatment through self-pay usually means dipping into life savings – something not everyone can afford to do when the cost of hip or knee replacement surgery, for example, can easily top £15,000.
However, there are specialist companies (e.g. Chrysalis Finance, which works with several private health firms to provide loans) which are set up to give fast-track approval – usually in 48 hours – on loans to cover the cost of private treatment.
These are normally short-term loans with interest rates that vary from 0 to 15 per cent.
‘Lots of people don’t find it easy to pay a lump sum – or don’t have a big enough limit on their credit cards – but this allows them to cover it in instalments,’ says Chris Smith-Brown.
‘But double-check what the hospital fee covers – for hip replacement surgery it usually includes the operation, the hospital stay and any follow-up care.
‘It may not include the painkillers, crutches or the cost of the physiotherapy needed afterwards.’
So these need to be factored in to the amount you borrow.
Costs of treatment varies around the country with central London costing more than anywhere else
8. Save by choosing a different hospital
Insurance premiums are partly dictated by where you are in the country. If you live in central London, you will probably pay more than anyone else.
But one way to get costs down is to agree to see one of the insurance firms’ approved consultants who is based at a hospital out of the city, rather than on your doorstep. ‘You could save hundreds of pounds,’ says Chris Smith-Brown.
9. What if surgery goes wrong?
One crucial thing to be aware of when undergoing surgery in the private sector is that if the procedure is being done at a private hospital, it’s unlikely to have A&E or critical care units.
This is where you’d get the urgent help you need if something goes wrong – such as uncontrolled bleeding or a cardiac arrest (where the heart suddenly stops beating properly).
In these cases, patients are rushed to the nearest NHS hospital with an A&E department.
‘Always ask, during your initial meeting with the consultant, who is responsible if things go wrong and whether you will be treated at the private hospital or be taken to an NHS one,’ says Chris Smith-Brown.
10. Be clear about consultants' fees
Consultation costs can vary greatly between doctors. Fees can be found on the Private Healthcare Information Network website (phin.org.uk).
Insurance companies tend to only let you see consultants on their approved list, in which case the rate will be agreed.
However, in some cases, they charge more than your insurer has agreed, so you are liable for the difference.
After you’ve met your consultant, whether self-pay or through private health insurance, they must send you a letter that sets out their fees for any additional diagnostic tests as well as for your treatment.
How to find the best health insurance for you and your family
by Elizabeth Anderson
It’s the one insurance you hope not to use, but should you fork out for private medical cover for you and your family and, if so, how do you know if you are getting good value for money?
With the NHS continuing to feel the pressure, we know that health insurance does give you quicker access to treatment and more choice over who provides it, where and when.
You can choose to pay a monthly or annual fee or ‘premium’ to an insurer.
If you develop a health condition or need a procedure, you then have the option of being treated and bypassing a likely lengthy wait on the NHS – with the cost funded fully or in-part by your insurer.
But the price can vary wildly depending on the insurer and the cover options you choose. The average cost will depend on multiple factors including your age, health and where you live.
To find out exactly how different the cost of policies can be, the Mail took out insurance with ten firms (including the four big names – Bupa, AXA Health, Aviva and Vitality – which account for 95 per cent of the health insurance market) to compare the prices.
The cost came in at around £70 a month for a single person aged 35; £120 for a couple in their late 30s; and £170 for a family including two young children. This assumed the insured had no pre-existing medical conditions, were non-smokers with a healthy weight and had a £250 excess.
So what do you get for your money?
All plans will cover treatment where you stay in hospital for either a day or overnight.
At its core, policies are there to pay for major surgery and, in most cases, cancer treatment, too. Some will offer mental health treatment – such as the chance to see a consultant or wellbeing therapist.
Be aware that you may not be asked much about your medical history when you buy the policy, but the insurer may well dig into it when you make a claim.
In most cases, medical conditions you’ve had in the five years before your policy starts won’t be covered by insurers.
It doesn’t stop there – and this is where it can get complicated.
You can add extras such as cover for mental health treatment, appointments, tests and scans to help diagnose your condition and more. At the point of taking the policy out, you’ll also have to choose which hospitals and consultants you have access to, as well as how much you’ll pay towards your treatment (through your excess).
Some insurers offer a limited number of hospitals where you can get treatment, or you can pay more to get access to a higher number of hospitals.
Insurers will differ on whether they pay outpatient costs and how much these can be. These costs arise from hospital appointments where you are not required to stay.
Related costs such as X-rays, biopsies or other diagnostic tests and specialist consultations are only covered in full if there is no limit on your outpatient allowance. Many insurers will have a cap, such as up to £500 a year (which can be breached quickly). You can pay extra for unlimited outpatient costs.
And while the cost of your health insurance plan rises each year (partly because you’re getting older), many health insurers offer no-claims discounts, so the price will not rise as much.
Chris Steele, founder of medical insurance comparison website myTribe, says that while prices from insurance providers may look similar, what they offer in their cover can be very different.
He says it’s vitally important to get everything right from the start, and to think about the provider you’d be happy to be with for several years.
While you can change your insurer, this can sometimes introduce new medical exclusions. ‘Health insurance is, unfortunately, extremely complicated,’ says Chris Steele.
‘I’ve spoken with people who weren’t aware of how claims might affect their renewal premiums. They then find it difficult to move elsewhere because the condition they claimed for is unlikely to be covered by the new insurer.
‘It’s best to get it right from the start by doing a bit of research or speaking to an insurance broker. Time spent up front will reduce the chance of nasty surprises down the road,’ he says.
You can find an insurance broker by searching the British Insurance Brokers’ Association website, or searching online for specialists and reading reviews.
Use our expert guide to help you decide on the best private health insurance cover
When it might be better to pay for treatment
Sometimes, the best option – depending on your finances – may be to pay for treatments or scans yourself, even if you already fork out for private medical insurance, says Chris Smith-Brown of the Private Health Information Network.
That’s because any insurance claim – even for a test or scan that might give you the all clear – is likely to bump up your premiums.
So if it’s a one-off procedure that will not need long-term follow-up care or management – such as cataract surgery or an endoscopy (where a probe with a tiny camera on the end is used to diagnose problems in the stomach or bowel) – paying separately may be the better choice, depending on your health policy.
‘Some people who have private medical insurance will self-pay for a consultation if they have a problem,’ says Chris Smith-Brown.
‘If it’s clear, then there is no effect on their premiums and if there is something that requires treatment, they should contact their insurer as soon as possible to see what can be done.’
But more people are now also opting for self-pay healthcare, funding private tests and treatments as and when they’re needed, rather than paying out on insurance policies they may never use. This is more common in people over the age of 70.
How much can I expect to self-pay?
If you opt for a self-pay approach, where you book to see a consultant privately and pay for it out of your own pocket, the doctor will usually charge between £90 and £250 for your initial consultation (possibly more if they’re an expert in their field and have a central London clinic).
If you go ahead with treatment, you’ll get an itemised estimate breaking down the consultant’s fees, the cost of any diagnostic tests and the treatment itself.
Anthony Mackintosh was informed his condition was not severe enough for NHS treatment
When Anthony Mackintosh developed pain around his right hip last year, he thought he’d pulled a muscle in his groin.
A keen gardener, he also loves playing with his five grandchildren and leads a very active lifestyle. But the pain rapidly worsened to the point where Anthony, a retired 64-year-old chauffeur who lives with his wife Lorraine in Northampton, was taking painkillers every day and struggling to walk more than a few steps at a time, or get in and out of the bath.
‘It was agony,’ says Anthony. ‘I lead a very outdoorsy life and was feeling very down about it as my life was on hold.’
What made things worse was that while his GP diagnosed osteoarthritis (wear and tear on the joint), he also said it was not severe enough to warrant referring him for hip replacement surgery on the NHS. Referral guidelines state the patient should have ‘persistent and disabling’ pain, struggle to walk, get dressed or bathe and be unable to work or socialise due to their discomfort.
Although Anthony appeared to tick most of these boxes, he says his GP still insisted he was not bad enough.
‘I ended up having to use two walking sticks just to get around the house,’ says Anthony. ‘I was in so much pain.’
A privately funded X-ray showed he had a bony growth on his hip joint, called a spur, as a result of the osteoarthritis, which the private doctor said was the source of much of the pain.
But when he returned to his GP with the results, Anthony was again informed his condition was still not severe enough.
In desperation, he made an appointment at a private hospital run by Wellsoon (part of the Practice Plus Group), where X-rays showed that within a few months of his last scan his hip had deteriorated considerably and was now bone-on-bone, as the cushioning cartilage had worn away.
Anthony had the £12,000 private surgery on a self-pay basis in January after borrowing money as well as scrapping holiday plans. But he insists it was money well spent, as he’s now fully mobile again and free of pain.
‘I was up and about on crutches within hours of the operation, lost the crutches within three days and was fully mobile at four weeks,’ he says. ‘We know the NHS does its best, but luckily we were in a financial position to pay so I could get back to my normal life.’
